Permit 1 11111 CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
s COMMUNITY DEVELOPMENT Permit #: ELR2011 -00054
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/08/2011
Parcel: 2S112DC00701
Jurisdiction: Tigard
Site address: 15951 SW 72ND AVE
Project: Miller Paint Subdivision: OREGON BUSINESS PARK III Lot: 38
Project Description: Low voltage for burglar alarm.
Contractor: PHILLIPS ELECTRONICS Owner: PACIFIC REALTY ASSOCIATES
3247 NW 29TH AVE 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97210 PORTLAND, OR 97224
PHONE: 503 - 222 -5083 PHONE: 503 - 624 -6300
FAX: 503 - 227 -4992
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/08/2011 $75.00
12% State Surcharge - Electrical 03/08/2011 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: N Instrumentation: N
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: Y Total $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATT- • • : • ••n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 0010 through OAR 9' •-00 •'90. You may obtain a copy of the rules or direct questions to OUNC by calling 50 .1987 or 1.800.332.2344.
Issu• • By: >� . / h_ i Permittee Signature: ' $ It =ariv
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application ,o. s@ ,., FOR OFFICE USE ONLY
'' Received
City of Tigard ' 1� Date /By: J r // z Permit No.: C fL £ Q� !/- tX C 5y
° 13125 SW Hall Blvd., Tigard, OR 9 ( 1,0 Plan Review
i D l Phone: 503.718.2439 Fax: 503.598 Other Permit:
Ins Line: 5036394175 ' • i ' M Date/By: - r Date Ready/By: Juris: ® See Page 2 for
. .
TIGARD Notified/Method: Supplemental www.tigard- or.gov pP lementalInformation
TYPE OF WORK PLAN REVIEW
❑ New construction ZAdditiort /alteratiort/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGRY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. m
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - and 2 family dwelling C ommercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A" "E" "1 -2" "1 -3"
/ F/ 7z _ 110011P or more. occupancy. parks.
no.: Job site address: J �/
❑
Six or more residential units. ❑Recreational vehicle arks.
City/State /ZIP: ; r `ia Y v. . Y ¢ El Health -care facilities. ❑ Supply voltage for more than
��`` G h ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: i Project name: /tsb'& � 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I *
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
U(�� I �ZH residential (with above sq. ft.) _
c. Y Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT C1 CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular i
City/State/ZIP: 67.84 2
ty dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
CONTRACTOR , Sign or outline lighting 67.84 2
S circuit(s) or limited- energy
Business name: Master Alarm LLC dba Phillips Electronics panel, alteration, or extension. Page 2 7s 2
Each additional inspection over allowable in any of the above
Address: 3247 NW 29th Avenue Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Portland OR 97210 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 222 - 5083 Fax: (503) 227 - 4992 Inspections for which no fee is 90.00/ hr
specifically listed (Y2 hr min)
CCB Lic.: 125364 Electrical Lic.: 26213CLE Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: e Subtotal: 7s--
Plan review (25% of permit fee):
Print name: Date: LJ I j State surcharge (12% of permit fee): ,•D
TOTAL PERMIT FEE:
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit.
1:\Building\ Permits \ELC- PermitApp.doc 07/01 /10 440- 4615T(li /05 /COM/wEB
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
El Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC •
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n O • tdoor Landscape Lighting*
• Protective Signaling
❑ O ther
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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